An unusual case of pancreatic and gastric neoplasms (2010: 12b). Malignant GISTs originating from the pancreas and stomach.

Gastrointestinal stromal tumors (GISTs) are the most common mesenchymal tumors of the digestive tract and are believed to originate from the neoplastic transformation of the interstitial cells of Cajal from their precursors. GIST can occur anywhere but mainly affects the stomach (60%), jejunum and ileum (30%), duodenum (4-5%), rectum (4%), colon, appendix and esophagus. Primary GISTs of the pancreas are very rare, with only five previous cases reported. This is an unusual case of multiple GISTs in the pancreas and stomach.

Peritoneal loose body presenting as a hepatic mass: A case report and review of the literature.

Peritoneal loose body (PLB) is a rare clinical entity. It is generally agreed that the most common origin of the loose bodies is appendix epiploica. We here report a case of PLB that looks like a "boiled egg," which was misdiagnosed preoperatively as a lesion of hepatic origin and was confirmed by operation and postoperative pathology. PLBs are rare entities, a good understanding of their specific imaging features can help prevent misdiagnosis, but sometimes an accurate preoperative diagnosis is still difficult to achieve. Exploratory laparoscopy is a recommended method for management of PLBs.

Idiopathic mesenteric phlebosclerosis associated with long-term oral intake of geniposide.

BACKGROUND: Idiopathic mesenteric phlebosclerosis (IMP) is a rare disease, and its etiology and risk factors remain uncertain. AIM: To investigate the possible influence of Chinese herbal liquid containing geniposide on IMP. METHODS: The detailed formula of herbal liquid prescriptions of all patients was studied, and the herbal ingredients were compared to identify the toxic agent as a possible etiological factor. Abdominal computed tomography (CT) and colonoscopy images were reviewed to determine the extent and severity of mesenteric phlebosclerosis and the presence of findings regarding colitis. The disease CT score was determined by the distribution of mesenteric vein calcification and colon wall thickening on CT images. The drinking index of medicinal liquor was calculated from the daily quantity and drinking years of Chinese medicinal liquor. Subsequently, Spearman's correlation analysis was conducted to evaluate the correlation between the drinking index and the CT disease score. RESULTS: The mean age of the 8 enrolled patients was 75.7 years and male predominance was found (all 8 patients were men). The patients had histories of 5-40 years of oral Chinese herbal liquids containing geniposide and exhibited typical imaging characteristics (e.g., threadlike calcifications along the colonic and mesenteric vessels or associated with a thickened colonic wall in CT images). Calcifications were confined to the right-side mesenteric vein in 6 of the 8 patients (75%) and involved the left-side mesenteric vein of 2 cases (25%) and the calcifications extended to the mesorectum in 1 of them. The thickening of colon wall mainly occurred in the right colon and the transverse colon. The median disease CT score was 4.88 (n = 7) and the median drinking index was 5680 (n = 7). After Spearman's correlation analysis, the median CT score of the disease showed a significant positive correlation with the median drinking index (r = 0.842, P < 0.05). CONCLUSION: Long-term oral intake of Chinese herbal liquid containing geniposide may play a role in the pathogenesis of IMP.

Perivascular epithelioid cell tumor of the liver: a report of two cases and review of the literature.

Perivascular epithelioid cell tumor (PEComa) is a rare tumor which arises from mesenchymal tissues. It is predominant in the uterus, but very rare in the liver. To the best of our knowledge, less than 5 cases of PEComa of the liver have been reported. Herein we present two pathologically proven cases of PEComa of the liver, retrospectively analyze their clinical and imaging features, and review the literature.

[Study on brain response to acupuncture by functional magnetic resonance imaging--observation on 14 healthy subjects].

OBJECTIVE: To observe the signal changes of brain functional area during needling Sanyinjiao (ST36), Zusanli (SP6) and Yanglingquan (GB34), the three acupoints in three different meridians, in human by functional magnetic resonance imaging (fMRI), in order to preliminary explore the neural mechanism of acupuncture. METHODS: Needling was complemented with 30 s of maneuver applying followed by 30 s of rest as a circle on an acupoint, and at the same time, fMRI was performed once 5 min and 12 s. Then the same program was repeated with the same mode on another acupoint, until ending the experiment. RESULTS: The commonly activated regions were postcentral gyrus and right inferior frontal gyrus when needling at ST36 and SP6, and the different activated areas included left inferior frontal gyrus, left insula, left inferior parietal lobule, left culmen, left middle temporal gyrus and left middle frontal gyrus, while no cortical signal enhanced region was found when needling at GB34. Signal weakened regions could be found when needling at all the three points, the commonly activated regions were bilateral parahippocampal, hippocampal, callosal gyrus, bilateral praecuneus and cerebellum. CONCLUSION: Brain response in special regions could be obtained by needling at different acupoints.

Imaging features of ciliated hepatic foregut cyst.

Ciliated hepatic foregut cyst (CHFC) is a very rare cystic lesion of the liver that is histologically similar to bronchogenic cyst. We report one case of CHFC that was hard to distinguish from solid-cystic neoplasm in imaging features. Magnetic resonance imaging was helpful in differentiating these cysts from other lesions.

[Angiographic diagnosis of gastrointestinal stromal tumors].

OBJECTIVE: To investigate the angiographic feature and its diagnostic value in gastrointestinal stromal tumor (GIST). METHODS: Twelve patients with pathologically proved GIST underwent angiography using PUCK and DSA one week before operation. The origin, size, morphology and angiographic appearance of the lesion were retrospectively analyzed. RESULTS: It was found that two tumors originated from stomach, eight from jejunum, and two from ileum. Seven cases were benign but five malignant. Obviously thickened and enlarged feeding artery was detected in eight tumors, and early-developed vein was found in three. Two types of angiographic changes of GIST were observed: 1) twisted irregular neoplastic vessels with partially coarse and indistinct margin were found in four cases, which were all malignant; 2) ball-like neoplastic vessels with homogeneous stain in tumor were found in eight cases, seven of them were benign but one was malignant. CONCLUSION: Angiography may be helpful in localization and diagnosis as well as defining the size of GIST, and especially in patients with melena of unknown origin.

Primary pancreatic paraganglioma: a report of two cases and literature review.

Paraganglioma is a rare tumor of paraganglia, derived from neural crest cells in sympathetic or parasympathetic ganglions. Primary paraganglioma originating from the pancreas is rare. We report two patients with paraganglioma in the head of the pancreas, in whom computed tomography showed a sharply marginated, hypervascular tumor with cystic areas. Significant intratumoral vessels and early contrast filling of the draining veins from the mass were not found. Although the pancreatic paraganglioma was located at the pancreatic head, the bile ducts often revealed no dilation, and sometimes the main pancreatic duct was mildly dilated. These findings are helpful in differentiating pancreatic paraganglioma from other pancreatic neoplasms. It is often difficult to distinguish between nonfunctional pancreatic paragangliomas and pancreatic endocrine tumors. In many reports,pancreatic paragangliomas show the retroperitoneal extension of a paraganglioma into the pancreas rather than a true pancreatic neoplasm. In surgical treatment, we could select simple excision of the tumor rather than radical surgery.

Angiographic findings of gastrointestinal stromal tumor.

AIM: To discuss the angiographic features of gastrointestinal stromal tumor (GIST) and to evaluate their diagnostic role. METHODS: Twelve patients with pathologically proved GIST underwent angiography (DSA)1 wk before operation, using Puck and digital subtraction DSA. The origin, size, morphology and angiographic appearance of the lesions were reviewed. RESULTS: Two tumors arose from stomach, 8 from jejunum, and 2 from ileum. Seven cases were benign and 5 were malignant. Obviously thickened supplying arteries were detected in 8 tumors, and early-developed veins were found in 3. Two types of angiographic changes of GIST were observed. Four cases had twisted irregular neoplastic vessels with partially coarse and indistinct margins, which were all malignant. Eight cases had ball-like neoplastic vessels with uniform tumor staining, of which 7 were benign and 1 was malignant. CONCLUSION: Angiography facilitates localization and diagnosis of GIST, helps define their size, range and location, and is especially valuable to patients suffering from melena with unknown reasons.

Small intestinal lipomas: diagnostic value of multi-slice CT enterography.

AIM: To analyze the clinical and imaging features of the small intestinal lipomas and to evaluate the diagnostic value of multi-slice computed tomography (CT) enterography. METHODS: Fourteen cases (one had two intestinal lesions) of surgically confirmed lipomas of the small intestine were retrospectively analyzed. The location, size, clinical and radiological aspects were discussed. RESULTS: Twelve patients presented with abdominal pain, of whom three complained of paroxysmal colic. Melena or bloody stools was mentioned in five cases. One lesion was detected incidentally during routine physical examination. One lesion was found unexpectedly during the preoperational evaluation for cholecystitis. Examination of the abdomen revealed palpable masses in four cases. Precontrast CT scan showed round or oval well-defined hypo-intense intraluminal masses with the attenuation ranging from -130 HU to -60 HU. On contrast enhancement CT scan, no striking enhancement was seen. CONCLUSION: The small intestinal lipomas are rare and difficult to diagnose merely based on clinical manifestations, while the characteristic features at small intestinal CT enterography can help establish reliable prospective diagnoses.